Your morning-after options

Every year, 3 million women in the U.S. have unintended pregnancies either because they skipped contraception or used it improperly.

If you dread having to make the difficult, life-altering decisions that come with an unplanned pregnancy, it’s not too latethere are “morning after” and now even “week after” emergency contraceptives.

Here are seven things to consider after having unprotected sex, including your options in terms of emergency contraception.

Your morning-after options

Every year, 3 million women in the U.S. have unintended pregnancies either because they skipped contraception or used it improperly.

If you dread having to make the difficult, life-altering decisions that come with an unplanned pregnancy, it’s not too latethere are “morning after” and now even “week after” emergency contraceptives.

Here are seven things to consider after having unprotected sex, including your options in terms of emergency contraception.

What not to do

One thing you shouldn’t do after unprotected sex is to try douching.

“Douching will not increase the risk of pregnancy, but it may increase the risk of pelvic infections,” says Lisa Perriera, MD, MPH, an assistant professor of obstetrics and gynecology at University Hospitals Case Medical Center, in Cleveland. “Douching in general is a bad idea.”

Why? It alters the normal balance of yeast and bacteria in the reproductive tract, which could lead to an infection.

Plan B

Plan B was the first hormonal product approved in the U.S. specifically for emergency contraception. It can prevent ovulation and fertilization if taken within three days (the sooner the better) of having unprotected sex.

Anyone can buy Plan B and its generic counterpart over the counter, meaning you don't need a prescription (although you may have to ask the pharmacist). Plan B costs between $10 and $70, according to Planned Parenthood.

Christopher Estes, MD, an assistant professor of clinical obstetrics and gynecology at the University of Miami Miller School of Medicine, recommends keeping it on hand in case of emergency.

Side effects can include nausea, tiredness, headache, and breast tenderness.

Ella

Ella (or ellaOne) is an emergency contraceptive approved by the FDA in 2010. It works in generally the same way as Plan B except that it’s effective if taken as many as five days after unprotected sex; it doesn’t seem to lose its effectiveness over that time span.

(Plan B contains the hormone progestin while Ella is ulipristal acetate, which has some progestin-like qualities.)

So far, Ella appears to be safe. Still, says Dr. Estes, it doesn’t have the same length of follow-up as Plan B, which has been on the market for more than a decade.

Side effects are similar to Plan B, and include nausea, tiredness, headache, and dizziness.

Copper IUD

Another type of emergency contraception is a copper IUD (ParaGard), which needs to be inserted by a doctor within five days after unprotected intercourse.

“It seems to work by increasing cervical mucus and repelling sperm,” says Beth Jordan, MD, medical director for the Association of Reproductive Health Professionals. Unlike the two emergency contraceptive pills, the copper IUDif you keep it inis effective for 10 or more years.

It could be costly, however, if your insurance doesn’t cover it: $500 to $1,000, according to Planned Parenthood. Side effects include cramping and bleeding between periods; they usually go away after the first few months.

Get STD tests

There’s little you can do to prevent sexually transmitted diseases (STD) after the fact, but you can still treat and manage them.

Experts recommend getting tested for gonorrhea, chlamydia, syphilis, HIV, and hepatitis B and C virus within a couple of weeks of unprotected sex. If the HIV and hepatitis results are negative, you’ll need to get retested in another six months to be absolutely sure.

If you think you’ve been exposed to HIV, you can take a prophylactic course of antiretrovirals. However, this is generally reserved for high-risk scenarios (for example, a health-care worker stuck with a needle or a rape victim). Make sure that you follow up on your STD tests to find out the results.

Monitor for pregnancy

Taking morning-after pills doesn’t guarantee that you won’t get pregnant. A study found that women who took ella or Plan B had a 1.8% and 2.6% chance, respectively, of getting pregnant.

That means you’ll still need to keep an eye on things, bearing in mind that a morning-after pill can cause spotting and may alter the flow of your period, which can make it hard to tell if you are pregnant.

"Many condom failures are just due to improper use,” Dr. Estes says. "It’s not put on the right way, it’s not worn the right way, you roll them inside out. When putting on a condom, you need to know exactly how to place it, from start to finish."